Calcium Silicate and Calcium Hydroxide Materials for Pulp Capping: Biointeractivity, Porosity, Solubility and Bioactivity of Current Formulations

Effect of TheraCal PT and Biodentine on inflammatory cell infiltration and hard tissue formation after pulpotomy in inflamed or healthy rat molars

OBJECTIVES

TheraCal PT is a novel resin-modified calcium-silicate material introduced for vital pulp therapies. This study aimed to investigate the inflammation and hard tissue formation after pulpotomy treatment with Biodentine and TheraCal PT in inflamed or healthy rat molar teeth.

METHODS

This study consisted of six groups (n = 12, 72 teeth): negative control-no preparation (NC); positive control (PC); Biodentine-pulpitis teeth (BD-P), TheraCal PT-pulpitis teeth (TPT-P), Biodentine-healthy teeth (BD-H), TheraCal PT-healthy teeth (TPT-P). For PC, BD-P and TPT-P groups, teeth were induced with lipopolysaccharide for 12 h. Pulpotomy procedure was performed with Biodentine and TheraCal PT. Eight weeks later, pulpal inflammatory cell infiltration and hard tissue formation were evaluated by histological analysis. Pearson's chi-square test was performed.

RESULTS

There were significant differences among groups for inflammation and hard tissue formation (p <.05). PC group showed moderate to severe inflammation. Biodentine groups showed lower inflammation scores than TheraCal PT groups. Pulpitis-induced groups showed higher inflammation scores than healthy groups. In Biodentine groups, complete hard tissue formation was higher than incomplete hard tissue formation. TheraCal PT groups showed mostly incomplete or no hard tissue formation. Pulpitis-induced groups showed inferior hard tissue formation scores than healthy groups.

CONCLUSIONS

TheraCal PT as a pulp capping material and inflamed pulp as a pre-treatment tooth condition showed inferior results in pulpotomy treatment. Biodentine exhibited favorable inflammatory pulpal responses and thicker hard tissue formation than TheraCal PT.

CLINICAL RELEVANCE

The novel resin-modified calcium-silicate material showed inferior inflammatory cell infiltration and hard tissue formation results in pulpotomy-treated teeth with irreversible pulpitis.

Effect of light-cured pulp capping materials on human dental pulp cells in vitro

AIM

Gold standard as material in vital pulp therapy (VPT) is hydraulic calcium silicate cements (HCSC). To circumvent their prolonged setting time, light-cured pulp capping materials containing calcium silicate or calcium hydroxide powder are available. Although their positive biological properties are advertised, the data regarding the biocompatibility of light-cured pulp capping materials (LCPCM) is inconclusive. This in vitro study compared the biocompatibility of five LCPCM containing calcium silicate (TheraCal LC, ReviCal, MTA PulpCap, Pulprotec MTA) or calcium hydroxide (Calcimol LC) with that of the HCSC Biodentine.

METHODS

Of each material, 226 cylindrical specimens (51.472 mm3) were prepared and incubated in a sterile cell culture medium (alpha Modified Eagle Medium) for 24 h to obtain an extract. Human dental pulp cells (hDPC) were added to the specimens and/or extracts. Cell viability and changes in cell morphology were examined (MTT, LDH, live-dead staining, light microscope). Calcium release from the materials (Ca2+ colorimetric assay) and the mineralisation capacity of the cells (Alizarin Red S Staining, Alkaline Phosphatase Assay) were determined. Statistical analysis was performed by anova and the post-hoc Tukey test (p < 0.05).

RESULTS

Compared to Biodentine, hDPC showed significantly lower cell viability when in contact with LCPCM (p < 0.05). Further, an inhibition zone around the test bodies or an altered cell morphology was observed. Biodentine showed almost no negative effects on cell viability or cell morphology. In contact with Biodentine, hDPC mineralise with and without mineralisation induction conditions. Among the LCPCM, mineralisation was only detectable under induction conditions with ReViCal and MTA PulpCap. In addition, Biodentine released significantly more calcium ions than the LCPCM (p < 0.05).

CONCLUSION

In this in vitro study, LCPCM showed cytotoxic effects on hDPC and were hardly able to induce cell mineralisation. Biodentine showed little negative effects on cell viability, induced cell mineralisation and released more calcium than LCPCM. Biodentine is significantly superior to LCPCM in terms of biocompatibility and mineralisation induction capacity.

Comparison of three dentine replacement materials in terms of different characteristics

This in vitro study evaluated three dentine replacement materials: Biodentine, Ketac Molar and TheraBaseCa. Specimens of each material (n = 19) were prepared for investigations of hardness, calcium release, pH and water sorption-solubility. SEM and EDX analysis were also used for these investigations. One-way ANOVA and robust ANOVA tests were used for normally and non-normally distributed data for statistical analysis, respectively. TheraBaseCa showed the lowest hardness (p < 0.001), while Biodentine had the highest pH and calcium release (p < 0.001). Significant differences in water sorption-solubility were observed as Biodentine>Ketac Molar>TheraBaseCa (p < 0.001). SEM and EDX revealed that Biodentine had a crystalline structure with O, Ca, C, Si and Bi; Ketac Molar had a particulate matrix with O, C, F, Ca, Si and Al; and TheraBaseCa had a matrix with C, O, Si, Yb, Al and Ca. In conclusion, Biodentine was more alkaline and released more calcium, while TheraBaseCa had the lowest water sorption-solubility over 28 days.

Impact of different capping materials extracts on proliferation and osteogenic differentiation of cultured human dental pulp stem cells

This study aimed to evaluate the effects of four bioactive capping material extracts on the proliferation and osteogenic differentiation of human dental pulp stem cells. Four capping material extracts were evaluated in this study [Harvard MTA (calcium silicate), Retro MTA (calcium zirconia complex material), Activa Bioactive Base/Liner (bioactive glass-based material) and an experimental MCP-based pulp capping material). The materials prepared according to their manufacturers' instructions in the form of discs. Each material disc was placed into one insert of a 6-well plate and covered with Dulbecco's Modified Eagle Medium to produce extracts at 1:1 ratio. Human dental pulp stem cells represent the negative control group, cells cultured in osteogenic media represent the positive control group, while cells cultured on the tested extracts represent the test groups. Each specimen was assessed in triplicate by three independent assays. The proliferation of stem cells was evaluated via MTT assay and cell viability was determined by measuring optical density. Osteogenic differentiation was assessed via the alizarin red stain test by measuring the H-score and calcium concentration. The proliferation and osteogenic differentiation data were analyzed using one-way ANOVA followed by Tukey's post hoc multiple comparison test (p ≤ 0.05). Regarding MTT assay results, osteogenic media was significantly greater than calcium zirconia complex and MCP-based material. In comparison with negative control and calcium zirconia complexes, calcium silicate significantly increased the optic density. Alizarin red staining revealed significantly low H-scores and calcium concentrations in the four tested capping materials in comparison with control group. The calcium concentration of calcium silicate material was significantly greater than the remaining tested materials.Calcium silicate-based materials seem to have the most reliable performance concerning the proliferation and osteogenic differentiation of human dental pulp stem cells. Newly introduced resin-based materials have shown acceptable results but need further investigation. The present study had a few limitations; mainly the need to perform more laboratory evaluations and in vivo studies.

Chemical and in vivo analyses of calcium silicate-based materials in bone and connective tissues

AIM

Calcium silicate-based cements have been widely used in dentistry mainly due to their physicochemical and biological properties. Commercially available materials use radiopacifiers containing metals (bismuth, tantalum, tungsten and/or zirconium). To investigate volumetric changes, in vivo biocompatibility and systemic migration from eight commercially available materials, including powder/liquid and 'ready-to-use' presentations.

METHODOLOGY

After characterization, tubes were implanted in healthy Wistar rats' alveolar bone and subcutaneous tissues. Micro-CT was used to evaluate volumetric change before/after 30 days of implantation. Histological and immunohistochemistry analysis were used to evaluate materials' biocompatibility. After euthanasia, kidney samples were retrieved, acidic digested and evaluated by inductively coupled plasma mass spectrometry (ICP-MS) for bismuth, tantalum, tungsten and zirconium mass fractions. Statistical analysis compared the results for normality and comparisons adopted a level of significance of 0.05.

RESULTS

Characterization photomicrographs and spectroscopy analysis revealed calcium, silicon and radiopacifiers for tested cements. Volumetric changes after implantation showed higher alteration in subcutaneous tissues than alveolar bone indicating that Biodentine, EndoSequence BC RRM Putty and ProRoot MTA were the most stable materials. Histological analysis found intense inflammation for NeoPUTTY and moderate for the other materials; osteocalcin and osteopontin were positively marked for all materials. Despite its volumetric stability, ProRoot MTA showed a 1000-fold higher mass fraction of bismuth accumulation and MTA Repair HP a 37-fold higher tungsten accumulation in kidney samples when compared with the nonexposed controls. All tantalum-analysed samples indicated a similar mass fraction with the nonexposed controls. Biodentine exhibited a significant lower kidney mass fraction of zirconium accumulation when compared with this control.

CONCLUSIONS

Volumetric analysis revealed that Bio-C Repair, NeoPUTTY and MTA Repair HP presented greater volumetric loss when implanted in the subcutaneous tissue. NeoPUTTY presented more intense inflammatory infiltrate. Systemic migration analysis highlighted the predominance of bismuth in the ProRoot MTA group. These results suggest that endodontic repair cements are affected by their chemical composition, the type of implant tissue and different clinical settings.

Evaluation of volumetric and surface stability of calcium silicate-based repair cements at different pHs

OBJECTIVES

The objective of this research was to evaluate the volumetric and surface stability in vitro, to different pH levels, of calcium silicate-based repair cements ready-to-use and powder/liquid exposed.

MATERIALS AND METHODS

Sixty human teeth were retro-prepared to a depth of 3 mm and divided into two groups. The first group included powder/liquid cements Biodentine (Septodont, France) and MTA HP (Angelus, Brazil); the second group included ready-to-use cements Bio-C Repair (Angelus, Brazil) and ENDOCEM MTA (Maruchi, Republic of Korea). All samples were submerged in PBS solution with pH levels of 5, 7, and 12. Initially, the materials were evaluated for porosity, marginal adaptation, and volumetric change using micro-CT, and then re-evaluated after 7 and 30 days of exposure to PBS solution. The samples were characterized using SEM/EDS and RAMAN spectroscopy. Statistical evaluation was performed using ANOVA with a 5% significance level.

RESULTS

Bio-C Repair showed significant statistical differences (p < 0.05) at different pHs in 7 and 30 days compared to other materials, being greater in acidic medium. ENDOCEM, regardless of pH, at 30 days showed fewer voids when compared to other repair cements.

CONCLUSION

This micro-CT study demonstrated that regardless pH, the clinic presentation of calcium silicate-based materials ready-to-use showed higher and loss volumetric than powder/liquid materials at 30 days.

CLINICAL RELEVANCE

Under neutral pH conditions, calcium silicate-based materials are expected to maintain properties such as bioactivity and low solubility. However, in clinical situations involving infection and inflammation, pH variations can impact the physicochemical properties of these materials regardless of their clinical presentation.

Antibacterial, biocompatible, and mineralization-inducing properties of calcium silicate-based cements

BACKGROUND

Different pulp capping materials have different origins and compositions, require different preparations, and may vary in their bioactive properties.

AIM

The purpose of this study was to evaluate the antibacterial activity, biocompatibility, and mineralization-inducing potential of calcium silicate-based pulp capping materials.

DESIGN

Six contemporary calcium silicate-based cements, ProRoot MTA, MTA Angelus, Biodentine, EndoSequence, NeoMTA 2, and NeoPutty, were evaluated. The antibacterial effects of these materials against Streptococcus mutans UA159 and Enterococcus faecalis ATCC 29212 were determined by the agar diffusion assay and the direct culture test. The biocompatibility and mineralization-inducing potential of these materials in preodontoblastic 17IIA11 cells were evaluated by the MTT assay and by Alizarin Red S staining, respectively.

RESULTS AND CONCLUSION

In agar diffusion test, only Biodentine showed distinct antibacterial effects against S. mutans. All the tested materials, however, showed antibacterial effects against S. mutans and E. faecalis in the direct culture test, with Biodentine showing the strongest growth inhibition against both S. mutans and E. faecalis. All the tested materials showed acceptable biocompatibility and mineralization-supporting potential in our experimental conditions. In summary, ProRoot MTA, MTA Angelus, Biodentine, EndoSequence, NeoMTA 2, and NeoPutty demonstrated acceptable in vitro antimicrobial, biocompatible, and mineralization-supporting properties.

Comparison of Modified NeoPutty MTA®, Biodentine, and Calcium Hydroxide in Indirect Pulp Therapy in Deciduous Teeth: An In Vivo Clinical Study

BACKGROUND

Pulp capping is a vital dental procedure used to preserve the vitality of teeth affected by deep caries lesions without irreversible pulpitis. The use of modern bioceramic materials has enhanced the predictability of vital pulp therapy (VPT).

AIM

This study aimed to assess the clinical success of Biodentine, modified NeoPutty mineral trioxide aggregate (MTA), and calcium hydroxide (Ca(OH)2) as pulp capping materials for indirect pulp capping in carious primary teeth.

MATERIALS AND METHODS

Indirect pulp treatment (IPT) was performed on 36 deciduous molars in 36 patients presenting with deep carious lesions. The teeth were randomly assigned to three groups: Biodentine (12 teeth), NeoPutty MTA (12 teeth), and Ca(OH)2 (12 teeth). Patients were monitored at 1, 3, and 6 months post-treatment to evaluate the clinical success of the procedures.

STATISTICAL ANALYSIS

Statistical analysis was conducted using Statistical Package for the Social Sciences (SPSS) software version 21.0. Pearson's Chi-squared test was employed to compare success and failure rates among Biodentine, MTA, and Ca(OH)2 at three different time intervals (30, 90, and 180 days) and overall success and failure rates regardless of the time intervals.

RESULTS

In the statistical analysis, different pulp capping materials yielded varying success rates. The NeoPutty MTA group demonstrated a success rate of 91.67%, the Biodentine group 83.33%, and the Ca(OH)2 group 58.33% after 6 months. However, these differences were not statistically significant.

CONCLUSION

Indirect pulp treatment with calcium silicate-based materials, such as Biodentine and modified NeoPutty MTA, showed superior results compared to the use of calcium hydroxide (Ca(OH)2). Although differences in success rates were observed among the materials, they did not reach statistical significance.

HOW TO CITE THIS ARTICLE

Acharya S, Gurunathan D, Assiry AA, et al. Comparison of Modified NeoPutty MTA®, Biodentine, and Calcium Hydroxide in Indirect Pulp Therapy in Deciduous Teeth: An In Vivo Clinical Study. Int J Clin Pediatr Dent 2024;17(9):1025-1029.

Biological evaluation of novel phosphorylated pullulan-based calcium hydroxide formulations as direct pulp capping materials: An in vivo study on a rat model

AIM

Calcium hydroxide (CH) has been considered as a direct pulp capping materials (DPC) for the last decades despite having some limitations. Phosphorylate pullulan (PPL) incorporated with CH (CHPPL) is a novel biomaterial that was introduced as a promising DPC material. Thus, the aim of the study was to evaluate the inflammatory response and mineralized tissue formation (MTF) ability of PPL-based CH formulations on rat molars after DPC.

METHODOLOGY

This study consisted of six groups: CH with 1% PPL (CHPPL-1); 3% PPL (CHPPL-3); 5% PPL (CHPPL-5); Dycal and NEX MTA Cement (N-MTA) as the positive control, and no capping materials (NC). One hundred twenty maxillary first molar cavities were prepared on Wistar rats. After capping, all the cavities were restored with 4-META/MMA-TBB resin and pulpal responses were evaluated at days 1, 7, and 28. Kruskal-Wallis followed by Mann-Whitney U-test was performed with a significance level of 0.05. Immunohistochemical expression of IL-6, Nestin, and DMP-1 was observed.

RESULTS

At day 1, CHPPL-1, N-MTA, and Dycal exhibited no to mild inflammation, whilst CHPPL-3, CHPPL-5, and NC showed mild to moderate inflammation, and the results were significantly different (p < .05). At day 7, mild to moderate inflammation was observed in CHPPL-1, N-MTA, and Dycal, whereas CHPPL-3, CHPPL-5, and NC exhibited moderate to severe inflammation. Significant differences were observed between CHPPL-1 and N-MTA with NC (p < .05), CHPPL-1 and CHPPL-3 with CHPPL-5 and Dycal (p < .05), and CHPPL-3 with N-MTA (p < .05). A thin layer of mineralized tissue formation (MTF) was observed in all groups. At day 28, CHPPL-1, Dycal, and N-MTA showed no to mild inflammation, whilst CHPPL-3, CHPPL-5, and NC exhibited mild to severe inflammation, and statistically significant difference was detected (p < .05). CHPPL-1, Dycal, and N-MTA exhibited continuous MTF, whilst CHPPL-3, CHPPL-5, and NC had thicker and interrupted MTF. Significant differences were observed between CHPPL-1, CHPPL-3, and N-MTA with NC group (p < .05). Variable expressions of IL-6, Nestin, and DMP-1 indicated differences in the materials' impact on odontoblast-like cell formation and tissue mineralization.

CONCLUSIONS

These findings suggest that CHPPL-1 has the potential to minimize pulpal inflammation and promote MTF and had similar efficacy as MTA cement.

Evaluation of Microleakage and Shear Bond Strength of Two Different Calcium-based Silicate Indirect Pulp Capping Agents When Restored with Glass Ionomer Cement and Composite Resin Restoration: A Comparative In Vitro Study

Background

Indirect pulp therapy (IPT) is a conservative treatment approach that leaves the deepest caries adjacent to the pulp undisturbed in an effort to avoid pulp exposure. The result of IPT is primarily dependent on the biocompatibility, sealing capacity, adaptability of the overlying restoration to underlying dentin, and strength of the liner material utilized.

Aim

To evaluate shear bond strength (SBS) and microleakage of mineral trioxide aggregate (e-MTA) and biodentine when restored with glass ionomer cement (GIC) and composite resin after their initial set time.

Materials and methods

Around 40 extracted caries-free permanent molars were randomly divided into two groups according to the liner material used (group I (e-MTA) and group II-biodentine). Each group was further divided into subgroups A1, A2, B1, and B2, where A1 and B1 received GIC and A2 and B2 received composite resin restoration after the initial set time. Half of the samples from each subgroup were allotted to two test groups of SBS and microleakage evaluation. The SBS was evaluated using a universal testing machine, and microleakage was assessed using a dye penetration test. One-way analysis of variance (ANOVA) was used for intergroup comparison, and the paired sample t-test was used for intragroup comparison. Categorical data were analyzed using a nonparametric test at the 5% level of significance using Statistical Package for the Social Sciences (SPSS) version 21 for Windows.

Results

A statistically significant difference (p = 0.001) was found in SBS between the group (e-MTA) + composite and biodentine + composite, where the latter group showed the highest SBS. Microleakage was highest in the group (e-MTA) + GIC (0.6 ± 0.894) and lowest in the group biodentine + composite (0.2 ± 0.447). However, no statistically significant difference was found in microleakage among all four groups.

Conclusion

Within the constraints of this study, biodentine can be suggested as the pulp capping agent to be restored with composite resin restoration after its initial set time.

How to cite this article

Patel C, Patel M, Panchal M, et al. Evaluation of Microleakage and Shear Bond Strength of Two Different Calcium-based Silicate Indirect Pulp Capping Agents When Restored with Glass Ionomer Cement and Composite Resin Restoration: A Comparative In Vitro Study. Int J Clin Pediatr Dent 2024;17(9):1035-1040.

Cytotoxicity and cell migration evaluation of a strontium silicate-based root canal sealer on stem cells from rat apical papilla: an in vitro study

BACKGROUND

Calcium silicate-based bioceramics have been applied in endodontics as advantageous materials for years, many chemical components and new synthesizing methods were used to improve the base formulation of the materials for positively affecting the sealers properties. Recently, a novel biomaterial formulation, grounded in strontium silicate, has been introduced to the market, offering potential advancements in the field.

OBJECTIVE

To comparatively analyze the cytotoxicity and cell migration effects of a novel strontium silicate-based bioceramic material (CRoot SP) and those of calcium silicate-based (iRoot SP) and epoxide amine resin (AH Plus) sealers on stem cells derived from rat apical papilla(rSCAPs).

METHODS

rSCAPs were isolated and characterized in vitro and subsequently cultured in the presence of various concentrations of CRoot SP, iRoot SP and AH Plus extracts. Cytotoxicity was assessed by CCK-8 assay, and cell-migration capacity was assessed by using wound healing assays .

RESULTS

No significant differences in cell viability were observed in the 0.02 mg/mL and 0.2 mg/mL sealer groups. The cell viability of CRoot SP was consistently greater than that of iRoot SP at concentrations of 5 mg/mL and 10 mg/mL across all time points. Maximum cytotoxic effect was noted on day 5 with 10 mg/mL AH Plus.The scratch was partly healed by cell migration in all groups at 24 h, and the 0.02 mg/mL, and 0.2 mg/mL CRoot SP exerted beneficial effects on rSCAPs migration.

CONCLUSIONS

CRoot SP exhibited less cytotoxic than the iRoot SP and AH Plus extracts after setting. A lower concentration of CRoot SP thus promotes the cell migration capacity of rSCAPs, and it may achieve better tissue repair during root canal treatment.

Biological and physical properties of calcium hydroxide-based pulp-capping materials and their modifications

PURPOSE

To evaluate the biological and physical properties of calcium hydroxide-containing pulp-capping materials and their modifications with different solutions and antioxidant Resveratrol (RES) addition.

METHODS

Calcium hydroxide+distilled-water:C, calcium hydroxide+saline:S, calcium hydroxide+synthetic tissue fluid:STF, Dycal:D, calcium hydroxide+distilled-water+RES:C+RES, calcium hydroxide+saline+RES:S+RES, calcium hydroxide+synthetic tissue fluid+RES:STF+RES, Dycal+RES:D+RES were tested. Cytotoxicity was determined by WST-1. Antibacterial-activity was evaluated by agar-diffusion. The water-absorption and solubility were examined for ISO-6876 and ISO-3107. The color-change was evaluated by spectrophotometer. Radiopacity was evaluated for ISO-6876 and ISO-9917. The normal distribution and homogeneity were determined and comparisons were made with appropriate analysis and post hoc tests (P < 0.05).

RESULTS

The highest cell-viability was determined in the C+RES and the lowest was in D and D+RES after 24 h (P < 0.0001). RES-addition increased cell-viability and the highest rate was detected in C+RES, S+RES and STF+RES after 48 h (P < 0.0001). A limited inhibition-zone against Streptococcus mutans was detected in D and D+RES. RES-addition did not change the water-absorption in S and STF or the solubility in S group.

CONCLUSION

RES-addition may be used to increase the biocompatibility of calcium hydroxide without any adverse effect on physical properties. Saline may be the first choice as a mixing solution.

Evaluation of Antimicrobial Properties, Cell Viability, and Metalloproteinase Activity of Bioceramic Endodontic Materials Used in Vital Pulp Therapy

This study aimed to evaluate the antimicrobial properties, cell viability, and matrix metalloproteinase (MMP) inhibition capacity of several endodontic materials aimed at vital pulp therapy: Pro Root MTA®, EndoSequence®, Biodentine®, MTA Angelus®, TheraCal LC®, and BioC Repair®. The materials were prepared according to the manufacturer's instructions. Antimicrobial tests were conducted using a microcosm biofilm model, cell viability was assessed using murine fibroblasts (L929), and MMP activity was analyzed through electrophoresis. The results showed that BioC Repair®, Biodentine®, and EndoSequence® exhibited similar antimicrobial properties, while MTA Angelus® and ProRoot MTA® had inferior results but were comparable to each other. In terms of cell viability, no significant differences were observed among the materials. EndoSequence® demonstrated the highest MMP inhibition capacity. In conclusion, BioC Repair®, Biodentine®, EndoSequence®, and TheraCal® showed better antimicrobial properties among the tested materials. The materials did not exhibit significant differences in terms of cytotoxicity. However, EndoSequence® displayed superior MMP inhibition capacity.

Bioactive potential of Bio-C Temp demonstrated by systemic mineralization markers and immunoexpression of bone proteins in the rat connective tissue

Intracanal medications are used in endodontic treatment due to their antibacterial activity and ability to induce the periapical repair. Among the intracanal medications, the Calen (CAL; SS. White, Brazil) is a calcium hydroxide-based medication that provides an alkaline pH and releases calcium, exerting an antimicrobial activity. Bio-C Temp (BIO; Angelus, Brazil), a ready-to-use bioceramic intracanal medication, was designed to stimulate the mineralized tissues formation. Here, we investigated the bioactive potential of BIO in comparison to the CAL in the rat subcutaneous. Polyethylene tubes filled with medications, and empty tubes (control group, CG) were implanted in the subcutaneous tissue of rats. After 7, 15, 30 and 60 days, the blood was collected for calcium (Ca+2) and alkaline phosphatase (ALP) measurement, and the capsules around the implants were processed for morphological analyses. The data were submitted to two-way ANOVA and Tukey test (p < 0.05). At 7, 15 and 30 days, the ALP level was grater in BIO and CAL than in CG (p < 0.0001). At 7 and 15 days, greater Ca+2 level was seen in the serum of CAL samples. From 7 to 60 days, an increase in the number of fibroblasts, osteocalcin- and osteopontin-immunolabelled cells was observed in BIO and CAL groups (p < 0.0001). In all periods, BIO and CAL specimens showed von Kossa-positive structures. Moreover, ultrastructural analysis revealed globules of mineralization in the capsules around the BIO and CAL specimens. Thus Bio-C Temp caused an increase in the ALP, osteocalcin and osteopontin, which may have allowed the formation of calcite, suggesting bioactive potential.

Comparative Evaluation of the Efficacy of TheraCal LC, Mineral Trioxide Aggregate, and Biodentine As Direct Pulp Capping Materials in Patients With Pulpal Exposure in Posterior Teeth: A Triple-Blinded Randomized Parallel Group Clinical Trial

Background The aim was to evaluate and compare the efficacy of TheraCal LC, mineral trioxide aggregate (MTA), and Biodentine as direct pulp capping (DPC) materials in patients with pulpal exposure in the posterior teeth. Methodology A total of 54 samples were assessed for eligibility. Out of this, 12 teeth samples failed to meet the inclusion criteria. Finally, 42 teeth samples were selected which were randomly distributed into three groups (n = 14). Groups A, B, and C received the intervention of MTA, Biodentine, and TheraCal LC, respectively. The assessment was performed clinically to check for postoperative pain, tenderness, and neural sensibility, and the radiographs were used to check the presence of periodontal ligament (PDL) space widening, calcified barrier, and periapical radiolucency at the follow-up of 21 days, three months, and 12 months. The outcomes depended on the clinical and radiographic success rates recorded at 12 months of recall. Results Overall successful outcome of DPC clinically at different periods was 97.61% at three months and 88.09% at 12 months. A Chi-square test was used which showed that the difference was statistically nonsignificant. For groups A, B, and C, the success rate at follow-up came out to be 85.71%, 100%, and 78.57% at 12 months, respectively. The overall radiographic success rate of DPC at different time periods was 83.33% at three months and 88.09% at 12 months. A Chi-square test was used which showed that the difference was statistically nonsignificant. For groups A, B, and C, the success rate at follow-up came out to be 85.71%, 100%, and 78.57% at 12 months, respectively. Conclusion Resin-based calcium-silicate agent (TheraCal LC) showed good efficacy and can be used in practice with the predictability of a good success rate both clinically and radiographically. Thus, TheraCal LC can be utilized as an alternative to MTA or Biodentine in clinical practice, with the predictability of similar successful outcomes in patients with pulpal exposure in the posterior teeth.

Synthesis of a Calcium Silicate Cement Containing a Calcinated Strontium Silicate Phase

Objectives

The positive effects of strontium on dental and skeletal remineralization have been confirmed in the literature. This study aimed to assess the properties of a calcium silicate cement (CSC) containing a sintered strontium silicate phase.

Materials and Methods

The calcium silicate and strontium silicate phases were synthesized by the sol-gel technique. Strontium silicate powder in 0 (CSC), 10 (CSC/10Sr), 20 (CSC/20Sr), and 30 (CSC/30Sr) weight percentages was mixed with calcium silicate powder. Calcium chloride was used in the liquid phase. X-ray diffraction (XRD) of specimens was conducted before and after hydration. The setting time and compressive strength were assessed at 1 and 7 days after setting. The set discs of the aforementioned groups were immersed in the simulated body fluid (SBF) for 1 and 7 days. The ion release profile was evaluated by inductively coupled plasma-optical emission spectrometry (ICP-OES). Biomineralization on the specimen surface was evaluated by scanning electron microscopy/energy dispersive X-ray spectroscopy (SEM/EDS). Data were analyzed by the Kolmogorov-Smirnov test, one-way and mixed ANOVA, Levene's test, and LSD post hoc test (P  < 0.05).

Results

Except for an increasement in the peak intensity of hydrated specimens, XRD revealed no other difference in the crystalline phases of hydrated and nonhydrated specimens. The compressive strength was not significantly different at 1 and 7 days in any group (P  > 0.05). The setting time significantly decreased by an increase in percentage of strontium (P  < 0.05). Release of Ca and Si ions significantly decreased by an increase in percentage of strontium (P  < 0.05). SEM/EDS showed the formation of calcium phosphate deposits at 1 and 7 days.

Conclusion

Incorporation of 10-30 wt% sintered strontium silicate phase as premixed in CSC can significantly decrease the setting time without compromising the compressive strength or biomineralization process of the cement.

Clinical Comparison of Three Indirect Pulp Capping Restorative Protocols: A Randomized Controlled Prospective Study

OBJECTIVES

The objective of this prospective double-blind clinical trial was to compare clinical outcomes of indirect pulp capping restorative protocols on permanent teeth over a 12-month period.

METHODS AND MATERIALS

Deep carious lesions in permanent teeth (90) were randomly assigned to three indirect pulp capping protocols (n=30: TheraCal LC, Dycal, and no liner). All teeth were restored with resin composite. The outcome measures were pain (VAS scale) and success rate (pulp vitality based on percussion, palpation, cold test, and radiographic findings), collected at screening, intervention, and 24-hour, 7-day, 3-month, 6-month, and 12-month follow-up visits.

RESULTS

There was no statistically significant difference in tooth sensitivity among the three indirect pulp capping protocols nor in success rates among the restorative protocols after 1 year of follow-up (p>0.1).The respective success rates, as defined by the tooth remaining vital, after 1 year were: 96.2% for TheraCal LC, 100% for Dycal, and 100% for no liner.

CONCLUSIONS

After 12-month evaluation, the success rate of indirect pulp capping therapy on permanent teeth was not affected by the pulp capping restorative protocol.

The microstructure, composition, physical properties, and bioactivity of calcium silicate cement prototypes for vital pulp therapies

Hydraulic calcium silicate cements (HCSCs) are valuable for various dental procedures. However, several reports document inherent limitations and complaints about their high costs, hindering accessibility in low-and middle-income countries. This study aimed to characterize four low-cost HCSC prototypes to show their microstructure, composition, and fundamental physical properties. Four HCSC prototypes were formulated: 1- calcium silicate powder with 17.5 wt. % replacement of calcium tungstate, 2- calcium silicate powder with 17.5 wt. % replacement of zirconium oxide, 3- calcium silicate powder with 17.5 wt. % replacement of calcium tungstate and 2.5 wt. % of zirconium oxide and 4- calcium silicate powder with 10 wt. % replacement of calcium tungstate and 10 wt. % replacement of zirconium oxide. Scanning electron microscopy, energy-dispersive X-ray spectroscopy, and X-ray diffraction were used to assess their microstructure and composition. Additionally, radiopacity, setting time, solubility, pH, and in vitro bioactivity were evaluated at different time points and contrasted with controls (Mineral trioxide aggregate -MTA Angelus- and Intermediate restorative material -IRM-). Their production cost was significantly lower than commercially available HCSCs. All prototypes exhibited a microstructure and composition comparable to MTA Angelus. All the prototypes exhibited radiopacity exceeding 3 mm of aluminum and shorter initial and final setting times than MTA Angelus. The solubility of some prototypes closely adhered to the ISO standard recommendation of 3% after 1 day, and all promoted an alkaline pH and the formation of calcium/phosphate precipitates. These promising findings suggest the potential clinical application of these prototypes. However, further research is necessary to evaluate their mechanical and biological properties for definitive clinical use.

LAMA5-inspired adhesive dodecapeptide facilitates efficient dentine regeneration: An in vitro and in vivo study

AIM

The primary goal of this study was to investigate the potential effects of A5G81 in inducing reparative dentine (RD) formation both in vitro and in vivo.

METHODOLOGY

Cell adhesion was observed by crystal violet staining and quantified by Sodium Dodecyl Sulphate (SDS) extraction. Cell proliferation was investigated using Cell Counting Kit-8 (CCK-8) assay. Spreading of cytoskeleton was visualized using immunofluorescence staining. Protein expression level of Akt signalling pathway was compared in a human Akt pathway phosphorylation array. Genes that were up or downregulated by A5G81 were identified by RNA sequencing. The mRNA expression of odontoblastic markers was detected by quantitative real-time polymerase chain reaction (qPCR). Moreover, mineralization of human dental pulp cells (hDPCs) was visualized by alizarin red staining and quantified using cetylpyridinium chloride (CPC). A direct pulp-capping model was established in SD rats and the RD formation at 2 weeks after operation was observed using HE staining.

RESULTS

A5G81 (optimal coating concentration: 0.5 mg/mL) promoted hDPCs adhesion and proliferation to a level that was similar to Type I collagen (COL-1). Meanwhile, A5G81 activated Akt signalling pathway, albeit to a lesser extent than COL-1. An inhibition test indicated that A5G81 induced hDPCs adhesion by activating PI3K pathway. A5G81 induced the expression of ECM remodelling genes and odontoblastic genes, which were demonstrated by RNA-seq and qPCR, respectively. In addition, A5G81 efficiently accelerated the mineralization of hDPCs in both immobilized and soluble forms, a property that makes it more applicable in dental clinic. Finally, the pulp-capping study in rats suggested that use of A5G81 could successfully induce the formation of RD within 2 weeks.

CONCLUSION

Coating of A5G81 to non-tissue culture-treated polystyrene facilitates spreading, proliferation and differentiation of hDPCs, resulting in rapid RD formation in artificially exposed pulp.

Comparative biological properties of resin-free and resin-based calcium silicate-based endodontic repair materials on human periodontal ligament stem cells

OBJECTIVES

To investigate the effect of three different calcium silicate-based materials (CSBM) on the biological behavior of human periodontal ligament stem cells (hPDLSCs).

METHODS

Eluates of Biodentine, NeoPutty and TheraCal PT prepared at 1:1, 1:2, and 1:4 ratios were extracted under sterile conditions. The cytotoxicity of the extracts to the hPDLSCs was assessed using the MTT assay. Scratch wound healing assay was utilized for assessing cell migration. Scanning electron microscopy was used to detect cell attachment and morphology. Calcium ion release was measured using inductively coupled plasma-optical emission spectrometry; the pH-value was evaluated with a pH-meter. ANOVA with post hoc Tukey test was used for statistical analysis.

RESULTS

Cell viability was significantly higher for Biodentine and NeoPutty at day 1 with all dilutions (p < 0.05), while at day 3 and day 7 with dilutions 1:2 and 1:4; all materials showed similar behavior (p > 0.05). Biodentine had the highest percentage of cell migration into the scratched area at day 1 for all dilutions (p < 0.05). Stem cells were attached favorably on Biodentine and NeoPutty with evident spreading, and intercellular communications; however, this was not shown for TheraCal PT. Biodentine showed the highest pH values and calcium ion release (p < 0.05).

CONCLUSIONS

The resin-free CSBM showed better performance and favorable biological effects on hPDLSCs and were therefore considered promising for usage as endodontic repair materials.

CLINICAL SIGNIFICANCE

Proper selection of materials with favorable impact on the host stem cells is crucial to ensure outcome in different clinical scenarios.

Synergistic effect of ion-releasing fillers on the remineralization and mechanical properties of resin-dentin bonding interfaces

In modern restorative dentistry, adhesive resin materials are vital for achieving minimally invasive, esthetic, and tooth-preserving restorations. However, exposed collagen fibers are found in the hybrid layer of the resin-dentin bonding interface due to incomplete resin penetration. As a result, the hybrid layer is susceptible to attack by internal and external factors such as hydrolysis and enzymatic degradation, and the durability of dentin bonding remains limited. Therefore, efforts have been made to improve the stability of the resin-dentin interface and achieve long-term clinical success. New ion-releasing adhesive resin materials are synthesized by introducing remineralizing ions such as calcium and phosphorus, which continuously release mineral ions into the bonding interface in resin-bonded restorations to achieve dentin biomimetic remineralization and improve bond durability. As an adhesive resin material capable of biomimetic mineralization, maintaining excellent bond strength and restoring the mechanical properties of demineralized dentin is the key to its function. This paper reviews whether ion-releasing dental adhesive materials can maintain the mechanical properties of the resin-dentin bonding interface by supplementing the various active ingredients required for dentin remineralization from three aspects: phosphate, silicate, and bioactive glass.

Nano eggshell-based slurry as a direct pulp-capping material: In vitro characterization and histopathological assessment in an experimental animal model

AIM

Pulp vitality is essential for tooth integrity. Following pulp exposure, choosing a suitable pulp-capping material is crucial to maintain pulp vitality. However, the reparative dentine bridge created by calcium hydroxide (Ca(OH)2 ) is generally porous and incomplete. The aim of the current study is to assess the in vitro and in vivo bioactivities of nano eggshell-based slurry (NES), using NES as a direct pulp-capping material, compared with Ca(OH)2 in rabbit animal model.

METHODOLOGY

Nano eggshell powder (NE) was characterized for particle morphology, chemical composition and ion release. In vitro bioactivity was tested by immersion in simulated body fluid (SBF) for 7 days. For histopathological evaluation, 36 adult New Zealand rabbits (72 pulp exposures) were divided into nine groups (n = 8) according to the pulp-capping material (NES, Ca(OH)2 and no capping as negative control group) and the animals were sacrificed after 7, 14 or 28 days. The pulps of the two lower central incisors were exposed and then directly capped by Ca(OH)2 or NES or left untreated. The cavities were then sealed with glass ionomer cement. Teeth were collected for histopathological evaluation using an optical microscope. Pulp haemorrhage, inflammation, fibrosis and calcific bridge formation were assessed. Results were statistically analysed using anova and Tukey's tests.

RESULTS

Nano eggshell particles were spherical with a 20 nm diameter and were composed mainly of calcite. Statistical analysis showed that there was a significant increase in the release of all investigated ions between days 1 and 28, except for copper. NES group showed a significantly higher release of all elements as compared to Ca(OH)2 . Environmental scanning electron microscope micrographs of NES incubated for 7 days in SBF showed the formation of HAp with a Ca/P ratio (1.686). For histopathological evaluation, the difference between groups was statistically significant. At day 28, 75% of the pulps of the Ca(OH)2 group showed mild calcific bridge in comparison with 100% moderate calcific bridge in the NES group. The NES group showed significantly less inflammation at days 7 and 28, and higher fibrosis at day 7 compared with Ca(OH)2 .

CONCLUSIONS

Nano eggshell-based slurry represents a promising novel direct pulp-capping material with favourable pulp tissue response.

Rheological Properties and Setting Kinetics of Bioceramic Hydraulic Cements: ProRoot MTA versus RS

Hydraulic calcium silicate-based cements (HCSCs) have become a superior bioceramic alternative to epoxy-based root canal sealers in endodontics. A new generation of purified HCSCs formulations has emerged to address the several drawbacks of original Portland-based mineral trioxide aggregate (MTA). This study was designed to assess the physio-chemical properties of a ProRoot MTA and compare it with newly formulated RS+, a synthetic HCSC, by advanced characterisation techniques that allow for in situ analyses. Visco-elastic behaviour was monitored with rheometry, while phase transformation kinetics were followed by X-ray diffraction (XRD), attenuated total reflectance Fourier transform infrared (ATR-FTIR), and Raman spectroscopies. Scanning electron microscopy with energy-dispersive spectroscopy, SEM-EDS, and laser-diffraction analyses was performed to evaluate the compositional and morphological characteristics of both cements. While the kinetics of surface hydration of both powders, when mixed with water, were comparable, an order of magnitude finer particle size distribution of RS+ coupled with the modified biocompatible formulation proved pivotal in its ability to exert predictable viscous flow during working time, and it was more than two times faster in viscoelastic-to-elastic transition, reflecting improved handling and setting behaviour. Finally, RS+ could be completely transformed into hydration products, i.e., calcium silicate hydrate and calcium hydroxide, within 48 h, while hydration products were not yet detected by XRD in ProRoot MTA and were obviously bound to particulate surface in a thin film. Because of the favourable rheological and faster setting kinetics, synthetic, finer-grained HCSCs, such as RS+, represent a viable option as an alternative to conventional MTA-based HCSCs for endodontic treatments.

Biocompatibility, bioactive potential, porosity, and interface analysis calcium silicate repair cements in a dentin tube model

OBJECTIVES

This study is to evaluate biocompatibility, bioactive potential, porosity, and dentin/material interface of Bio-C Repair (BIOC-R), MTA Repair HP (MTAHP), and Intermediate Restorative Material (IRM).

MATERIALS AND METHODS

Dentin tubes were implanted into subcutaneous of rats for 7, 15, 30, and 60 days. Thickness of capsules, number of inflammatory cells (ICs), interleukin-6 (IL-6), osteocalcin (OCN), and von Kossa were evaluated. Porosity and material/dentin interface voids were also analyzed. Data were submitted to ANOVA and Tukey's tests (p < 0.05).

RESULTS

IRM capsules were thicker and contained greater ICs and IL-6-immunopositive cells at 7 and 15 days. BIOC-R capsules exhibited higher thickness and ICs at 7 days and greater IL-6 at 7 and 15 days than MTAHP (p < 0.05). At 30 and 60 days, no significant difference was observed among the groups. OCN-immunopositive cells, von Kossa-positive, and birefringent structures were observed in BIOC-R and MTAHP. MTAHP exhibited higher porosity and interface voids (p < 0.05).

CONCLUSIONS

BIOC-R, MTAHP, and IRM are biocompatible. Bioceramics materials demonstrate bioactive potential. MTAHP presented the highest porosity and presence of voids.

CLINICAL RELEVANCE

BIOC-R and MTAHP have adequate biological properties. BIOC-R demonstrated lower porosity and presence of voids, which may represent better sealing for its clinical applications.

Immature permanent incisors with complicated crown fractures treated with partial pulpotomy using white mineral trioxide aggregate and IRoot BP plus-a retrospective long-term study

BACKGROUND/AIMS

Calcium silicate cements have been widely used for pulpotomies in immature permanent teeth with complicated crown fractures due to their superior properties. However, few studies have evaluated the long-term outcomes of white mineral trioxide aggregate (WMTA) and iRoot BP Plus for partial pulpotomies. The aim of this study was to investigate the long-term clinical and radiographic outcomes of WMTA and iRoot BP Plus for partial pulpotomies in immature permanent incisors with complicated crown fractures.

MATERIALS AND METHODS

Children who had partial pulpotomies of immature permanent incisors with complicated crown fractures using WMTA or iRoot BP Plus as capping agents were enrolled. Eighty immature permanent incisors in 68 children (aged 8-13 years) were included. They were divided into two groups (WMTA and iRoot BP Plus) according to the capping agents. Clinical and radiographic information was collected during a 5-year follow-up period. Study data were analyzed using Chi-square tests or Fisher exact tests.

RESULTS

The clinical and radiographic success rates in the WMTA (n = 36) and iRoot BP Plus groups (n = 44) were 94.4% versus 97.7% and 88.9% versus 97.7%, respectively (both p < .05). The average observation period was 74.5 ± 13.2 months and 61.9 ± 1.6 months in the WMTA and iRoot BP Plus groups, respectively (p < .01). Five cases presented with periapical radiolucencies. The WMTA group had four cases of pulp canal calcification (11.1%), while the iRoot BP Plus group had two cases (4.6%). There was crown discolouration in all cases in the WMTA group, but none in the iRoot BP Plus group.

CONCLUSION

Both WMTA and iRoot BP Plus had favorable outcomes in promoting physiological development and maintaining the basic functions of immature permanent incisors with complicated crown fractures. As a partial pulpotomy material, iRoot BP Plus may be more suitable for the esthetic zone than WMTA.

A comparative histological study of the effect of TheraCal LC and biodentine on direct pulp capping in rabbits: an experimental study

OBJECTIVES

This study histologically compared the effect of TheraCal LC and biodentine on direct pulp capping using a rabbit model.

MATERIALS AND METHODS

A direct pulp capping procedure was performed on 40 mandibular central incisors of 20 healthy, male New Zealand white rabbits. TheraCal LC and biodentine were applied to exposed pulp and 10 randomly selected rabbits were euthanized after the first and second week. Incisors were extracted and prepared for histological processing and examination to check the dentine bridge thickness, continuity, and extent of pulp inflammation. A blinded data analysis was performed, and groups were compared using a Wilcoxon signed-rank test while changes across time within each group were assessed using the Mann-Whitney U test.

RESULTS

When comparing the dentine bridge thickness, biodentine showed a significantly thicker dentine bridge in the first and second week (mean 28.16 µm, 33.66 µm), while TheraCal LC showed a dentine bridge in the second week only (mean 15.93 µm). Regarding dentine bridge continuity, biodentine showed a significantly better dentine bridge in the first week. Additionally, there was no difference in the second week. Furthermore, there was no statistically significant difference between each of the materials regarding the extent of inflammation.

CONCLUSIONS

Biodentine in vivo showed better results concerning thickness and continuity of the dentine bridge after direct pulp capping in rabbit incisors. Both biodentine and TheraCal LC had a similar inflammatory effect on the pulp.

CLINICAL RELEVANCE

Biodentine is more successful as a direct pulp capping material compared to TheraCal LC.

Fast-Setting Calcium Silicate-Based Pulp Capping Cements-Integrated Antibacterial, Irritation and Cytocompatibility Assessment

Calcium silicate-based cements (CSCs) are endodontic materials widely used in vital pulp-capping approaches. Concerning the clinical application, the reduced set time and pre-mixed formulations are relevant characteristics during the operative management of pulpal exposure, aiming to optimise the work time and improve cross-infection/asepsis control. Additionally, clinical success seems to be greatly dependent on the biological performance of the materials that directly contact the living pulp. As such, this work approaches an integrative biological characterisation (i.e., antibacterial, irritation, and cytocompatibility assays) of three fast-setting CSCs-Biodentine^TM, TotalFill^® BC RRM™ Fast Putty, and Theracal LC^®. These cements, after setting for 24 h, presented the expected topography and elemental composition (assessed by scanning electron microscopy, coupled with EDS analysis), in accordance with the information of the manufacturer. The set cements displayed a significant and similar antibiofilm activity against S. mutans, in a direct contact assay. Twenty-four-hour eluates were not irritant in the standardised CAM assay, but elicited distinct dose- and time-dependent cytotoxicity profiles on fibroblastic cells-i.e., Biodentine was devoid of toxicity, TotalFill presented a slight dose-dependent initial toxicity that was easily overcome, and Theracal LC was deleterious at high concentrations. When compared to long-setting ProRoot MTA cement, which highlighted the pursued integrative approach, Biodentine presented a similar profile, but TotalFill and Theracal LC displayed a poorer performance regarding antibiofilm activity/cytocompatibility features, and Theracal LC suggested eventual safety concerns.

Chemical-Physical Properties and Bioactivity of New Premixed Calcium Silicate-Bioceramic Root Canal Sealers

The aim of the study was to analyze the chemical−physical properties and bioactivity (apatite-forming ability) of three recently introduced premixed bioceramic root canal sealers containing varied amounts of different calcium silicates (CaSi): a dicalcium and tricalcium silicate (1−10% and 20−30%)-containing sealer with zirconium dioxide and tricalcium aluminate (CERASEAL); a tricalcium silicate (5−15%)-containing sealer with zirconium dioxide, dimethyl sulfoxide and lithium carbonate (AH PLUS BIOCERAMIC) and a dicalcium and tricalcium silicate (10% and 25%)-containing sealer with calcium aluminate, tricalcium aluminate and tantalite (NEOSEALER FLO). An epoxy resin-based sealer (AH PLUS) was used as control. The initial and final setting times, radiopacity, flowability, film thickness, open pore volume, water absorption, solubility, calcium release and alkalizing activity were tested. The nucleation of calcium phosphates and/or apatite after 28 days aging in Hanks balanced salt solution (HBSS) was evaluated by ESEM-EDX, vibrational IR and micro-Raman spectroscopy. The analyses showed for NeoSealer Flo and AH Plus the longest final setting times (1344 ± 60 and 1300 ± 60 min, respectively), while shorter times for AH Plus Bioceramic and Ceraseal (660 ± 60 and 720 ± 60 min, respectively). Radiopacity, flowability and film thickness complied with ISO 6876/12 for all tested materials. A significantly higher open pore volume was observed for NeoSealer Flo, AH Plus Bioceramic and Ceraseal when compared to AH Plus (p < 0.05), significantly higher values were observed for NeoSealer Flo and AH Plus Bioceramic (p < 0.05). Ceraseal and AH Plus revealed the lowest solubility. All CaSi-containing sealers released calcium and alkalized the soaking water. After 28 days immersion in HBSS, ESEM-EDX analyses revealed the formation of a mineral layer that covered the surface of all bioceramic sealers, with a lower detection of radiopacifiers (Zirconium for Ceraseal and AH Plus Bioceramic, Tantalum for NeoSealer Flo) and an increase in calcium, phosphorous and carbon. The calcium phosphate (CaP) layer was more evident on NeoSealer Flo and AH Plus Bioceramic. IR and micro-Raman revealed the formation of calcium carbonate on the surface of all set materials. A thin layer of a CaP phase was detected only on AH Plus Bioceramic and NeoSealer Flo. Ceraseal did not show CaP deposit despite its highest calcium release among all the tested CaSi-containing sealers. In conclusion, CaSi-containing sealers met the required chemical and physical standards and released biologically relevant ions. Slight/limited apatite nucleation was observed in relation to the high carbonation processes.

Comparative chemical properties, bioactivity, and cytotoxicity of resin-modified calcium silicate-based pulp capping materials on human dental pulp stem cells

OBJECTIVES

This study investigated the cytotoxicity, the residual monomer release, degree of conversion (DC), calcium ion (Ca²⁺) release, and crystal structure of TheraCal PT (ThPT) by comparison with TheraCal LC (ThLC) and mineral trioxide aggregate (MTA).

MATERIALS AND METHODS

The cytotoxicity of the cured materials was evaluated on human dental pulp stem cells (hDPSCs) isolated from third molars by the water-soluble tetrazolium salt (WST-1) method. The monomer release and DC of the resin-containing materials were analyzed by high-performance liquid chromatography (HPLC) and Fourier transform infrared (FTIR), respectively. The chemical composition and Ca²⁺ release of the materials were determined by scanning electronic microscopy-energy-dispersive spectroscopy (SEM-EDS), X-ray diffractometry (XRD), and inductively coupled plasma-optical emission spectroscopy (ICP-OES), respectively. Statistical differences were evaluated with one-way ANOVA, repeated measure ANOVA, and the Tukey test (p < 0.05).

RESULTS

MTA showed significantly lower cytotoxicity than either ThLC or ThPT after 1, 3, and 7 days (p < 0.05). TEGDMA release of ThPT is significantly higher than ThLC (p < 0.05). All materials showed calcium Ca²⁺ release, with MTA significantly higher than the others (p < 0.05).

CONCLUSIONS

MTA showed low cytotoxicity and high Ca²⁺ release compared to ThLC and ThPT.

CLINICAL RELEVANCE

The cytotoxicity and residual monomer release of ThLC and ThPT may raise concerns about the viability of hDPSCs. Further investigations with the use of in vivo research models are required to validate in vitro bioactivity properties and the potential adverse biological effects of ThLC and ThPT on hDPSCs.

An Updated Review on Properties and Indications of Calcium Silicate-Based Cements in Endodontic Therapy

Regarding the common use of calcium silicate cements (CSCs) in root canal therapy, their position in the context of past and present dentistry agents can provide a better understanding of these materials for their further improvement. In this context, the present review article addresses a wide range of recent investigations in the field of CSC-based products and describes details of their composition, properties, and clinical applications. The need for maintaining or reconstructing tooth structure has increased in contemporary endodontic treatment approaches. This research thus discusses the attempts to create comprehensive data collection regarding calcium ion release, bond strength, alkalinizing activity and bioactivity, and the ability to stimulate the formation of hydroxyapatite as a bioactive feature of CSCs. Sealing ability is also highlighted as a predictor for apical and coronal microleakage which is crucial for the long-term prognosis of root canal treatment integrity. Other claimed properties such as radiopacity, porosity, and solubility are also investigated. Extended setting time is also mentioned as a well-known drawback of CSCs. Then, clinical applications of CSCs in vital pulp therapies such as pulpotomy, apexification, and direct pulp capping are reviewed. CSCs have shown their benefits in root perforation treatments and also as root canal sealers and end-filling materials. Nowadays, conventional endodontic treatments are replaced by regenerative therapies to save more dynamic and reliable hard and soft tissues. CSCs play a crucial role in this modern approach. This review article is an attempt to summarize the latest studies on the clinical properties of CSCs to shed light on the future generation of treatments.

The Cytotoxicity and Genotoxicity of Bioactive Dental Materials

The promotion of biologically based treatment strategies in restorative dentistry is of paramount importance, as invasive treatments should be avoided to maintain the tooth's vitality. This study aimed to assess the biocompatibility of commercially available bioactive materials that can be used for dental pulp capping. The study was performed with a monocyte/macrophage peripheral blood SC cell line (ATCC CRL-9855) on the following six specific bioactive materials: ProRoot MTA (Dentsply Sirona), MTA Angelus (Angelus), Biodentine (Septodont), TheraCal LC (Bisco), ACTIVA BioACTIVE (Pulpdent) and Predicta Bioactive Bulk (Parkell). The cytotoxicity of the investigated agents was measured using a resazurin-based cell viability assay, while the genotoxicity was evaluated using an alkaline comet assay. Additionally, flow cytometry (FC) apoptosis detection was conducted with a FITC (fluorescein isothiocyanate) Annexin V Apoptosis Detection Kit I. FC cell-cycle arrest assessment was carried out with propidium iodide staining. The results of this study showed no significant cytotoxicity and genotoxicity (p > 0.05) in ProRoot MTA, MTA Angelus, Biodentine, ACTIVA BioACTIVE and Predicta Bioactive. Conversely, TheraCal LC presented a significant decrease (p < 0.001). In conclusion, due to excellent biocompatibility and low cytotoxicity, MTA, Biodentine, ACTIVA BioACTIVE and Predicta Bioactive may be suitable for pulp capping treatments. On the other hand, due to the high cytotoxicity of TheraCal LC, its use should be avoided in vital pulp therapies.

Trends of calcium silicate biomaterials in medical research and applications: A bibliometric analysis from 1990 to 2020

Background: Calcium silicate biomaterials (CSB) have witnessed rapid development in the past 30 years. This study aimed to accomplish a comprehensive bibliometric analysis of the published research literature on CSB for biomedical applications and explore the research hotspot and current status.

Methods: Articles related to CSB published in the last three decades (1990–2020) were retrieved from Web of Science Core Collection. The R bibliometrix package and VOSviewer were used to construct publication outputs and collaborative networking among authors, their institutes, countries, journals’ matrices and keywords plus.

Results: A total of 872 publications fulfilling the search criteria were included. CSB is mainly reported for bone tissues and dental applications. Among researchers, Chang J from Chinese Academy of Sciences and Gandolfi MG from the University of Bologna are the most productive author in these two fields, respectively. China was the leading contributor to the research on CSB in the medical field. A total of 130 keywords appeared more ten or more times were identified. The term “mineral trioxide aggregate” ranked first with 268 occurrences. The co-occurrence analysis identified three major clusters: CSB in dentistry, bone tissue and vitro bioactivity.

Conclusion: Calcium silicate biomaterials have a promising scope for various biomedical applications ranging from regeneration of hard tissues (bone and teeth) to skin, tumor, cardiac muscle and other soft tissues. This study may help researchers further understand the frontiers of the field.

Alkalizing Properties of Six Calcium-Silicate Endodontic Biomaterials

INTRODUCTION

Calcium silicate-based cements (CSC), are self-setting hydraulic biomaterials widely used for reparative procedures in dentistry and endodontics. These materials possess physical properties, such as ion release, porosity, solubility, and radiopacity. Their biological properties are connected to their alkalizing activity and calcium release capacity.

MATERIALS AND METHODS

Six calcium silicate-based materials were selected for this study: TheraCal LC (Bisco Inc., Schaumburg, IL, USA), MTA Plus (PrevestDenpro, Jammu, India Avalon Biomed Inc., Bradenton, FL, USA), Biodentine (Septodont, Saint-Maur-des-Fossés, France), RetroMTA (BioMTA, Seoul, Korea), MTA Flow (Ultradent Products, Inc., South Jordan, UT, USA), and OrthoMTA (BioMTA, Seoul, Korea). The pH was analyzed immediately after immersion (baseline) and after 1 h, 3 h, 1 day, 2 days, 3 days, 1 week, 2 weeks, 3 weeks, and 1 year with a pH meter, previously calibrated with solutions of known pH. All testing materials had alkaline pH.

RESULTS

Analysis of the tested materials showed statistically significant differences in terms of pH changes as a function of the time showed a gradual rise in the pH of all materials.

CONCLUSIONS

All tested materials exhibited continuous hydroxyl ion release resulting in a rise in pH until the end of time of experience.

In vitro physicochemical characterization of five root canal sealers and their influence on an ex vivo oral multi-species biofilm community

AIM

To evaluate the physicochemical properties of five root canal sealers and assess their effect on an ex vivo dental plaque-derived polymicrobial community.

METHODOLOGY

Dental plaque-derived microbial communities were exposed to the sealers (AH Plus [AHP], GuttaFlow Bioseal [GFB], Endoseal MTA [ESM], Bio-C sealer [BCS] and BioRoot RCS [BRR]) for 3, 6 and 18 h. The sealers' effect on the biofilm biomass and metabolic activity was quantified using crystal violet (CV) staining and MTT assay, respectively. Biofilm community composition and morphology were assessed by denaturing gradient gel electrophoresis (DGGE), 16S rRNA sequencing and scanning electron microscopy. The ISO6876:2012 specifications were followed to determine the setting time, radiopacity, flowability and solubility. Obturated acrylic teeth were used to assess the sealers' effect on pH. Surface chemical characterization was performed using SEM with coupled energy-dispersive spectroscopy. Data normality was assessed using the Shapiro-Wilk test. One-way anova and Tukey's tests were used to analyze data from setting time, radiopacity, flowability and solubility. Two-way anova and Dunnett's tests were used for the data analysis from CV, MTT and pH. 16S rRNA sequencing data were analyzed for alpha (Shannon index and Chao analysis) and beta diversity (Bray-Curtis dissimilarities). Differences in community composition were evaluated by analysis of similarity (p < .05).

RESULTS

The sealers significantly influenced microbial community composition and morphology. All sealers complied with ISO6876:2012 requirements for setting time, radiopacity and flowability. Although only AHP effectively reduced the biofilm biomass, all sealers, except BRR, reduced biofilm metabolic activity.

CONCLUSION

Despite adequate physical properties, none of the sealers tested prevented biofilm growth. Significant changes in community composition were observed. If observed in vivo, these changes could affect intracanal microbial survival, pathogenicity and treatment outcomes.

Present status and future directions: Hydraulic materials for endodontic use

BACKGROUND

Hydraulic materials are used in Endodontics due to their hydration characteristics namely the formation of calcium hydroxide when mixing with water and also because of their hydraulic properties. These materials are presented in various consistencies and delivery methods. They are composed primarily of tricalcium and dicalcium silicate, and also include a radiopacifier, additives and an aqueous or a non-aqueous vehicle. Only materials whose primary reaction is with water can be classified as hydraulic.

OBJECTIVES

Review of the classification of hydraulic materials by Camilleri and the literature pertaining to specific uses of hydraulic cements in endodontics namely intra-coronal, intra-radicular and extra-radicular. Review of the literature on the material properties linked to specific uses providing the current status of these materials after which future trends and gaps in knowledge could be identified.

METHODS

The literature was reviewed using PUBMED, and for each clinical use, the in vitro properties such as physical, chemical, biological and antimicrobial characteristics and clinical data were extracted and evaluated.

RESULTS

A large number of publications were retrieved for each clinical use and these were grouped depending on the property type being investigated.

CONCLUSIONS

The hydraulic cements have made a difference in clinical outcomes. The main shortcoming is the poor testing methodologies employed which provide very limited information and also inhibits adequate clinical translation. Furthermore, the clinical protocols need to be updated to enable the materials to be employed effectively.

Effect of Bioinductive Cavity Liners on Shear Bond Strength of Dental Composite to Dentin

Background

The aim of the current study was to evaluate and compare the influence of Dycal, Lime-Lite, TheraCal LC, Biodentine, resin-modified glass ionomer cement (RMGIC), and Activa BioActive as the pulp capping material on the shear bond strength of resin composite to dentin.

Methods

A total of 70 extracted caries-free molars were randomly assigned to seven groups. Six test groups were covered with various protective liners: Dycal, TheraCal LC, Lime-Lite, Activa BioActive, Biodentine, and RMGIC. The control group received no liner pretreatment. Each sample was bonded to resin composite using the total-etch Tetric N bond adhesive. The samples were then tested for shear bond strength using the universal testing machine at a cross-head speed of 1 mm/min until bond failure occurred. The data were analyzed using the one-way ANOVA test followed by the Tamhane post hoc test for pairwise comparisons of the groups.

Results

Independent of the type of the applied liner, all groups exhibited inferior SBS to dentin compared to the control group. TheraCal and RMGIC showed significantly higher shear bond strength than Biodentine and Dycal, which showed the lowest shear bond strength. Lime-Lite and Activa also had significantly lower SBS results than TheraCal. The mode of fracture was predominantly cohesive in Dycal, Biodentine, and TheraCal and adhesive in Activa.

Conclusion

This present study concludes that the bond strength of resin composite to dentin can be affected differently using various types of liners.

Mineral-induced bubbling effect and biomineralization as strategies to create highly porous and bioactive scaffolds for dentin tissue engineering

The objective of the study was to assess the biological and mechanical characteristics of chitosan-based scaffolds enriched by mineral phases and biomineralized in simulated body fluid (SBF) as a possible biomaterial for dentin regeneration. Thus, porous chitosan scaffolds were prepared by the mineral-induced bubbling-effect technique and subjected to biomineralization to create biomimetic scaffolds for dentin tissue engineering. Suspensions containing calcium hydroxide, nanohydroxyapatite, or β-tricalcium phosphate were added to the chitosan (CH) solution and subjected to gradual freezing and freeze-drying to obtain CHCa, CHnHA, and CHβTCP porous scaffolds, respectively, by the bubbling effect. Then, scaffolds were incubated in SBF for 5 days at 37°C, under constant stirring, to promote calcium-phosphate (CaP) biomineralization. Scanning electron microscopy revealed increased pore size and porosity degree on mineral-containing scaffolds, with CHCa and CHnHA presenting as round, well-distributed, and with an interconnected pore network. Nevertheless, incubation in SBF disrupted the porous architecture, except for CHCa_SBF , leading to the deposition of CaP coverage, confirmed by Fourier Transform Infrared Spectroscopy analyses. All mineral-containing and SBF-treated formulations presented controlled degradation profiles and released calcium throughout 28 days. When human dental pulp cells (HDPCs) were seeded onto scaffold structures, the porous and interconnected architecture of CHCa, CHnHA, and CHCa_SBF allowed cells to infiltrate and spread throughout the scaffold structure, whereas in other formulations cells were dispersed or agglomerated. It was possible to determine a positive effect on cell proliferation and odontogenic differentiation for mineral-containing formulations, intensely improved by biomineralization. A significant increase in mineralized matrix deposition (by 8.4 to 18.9 times) was observed for CHCa_SBF , CHnHA_SBF , and CHβTCP_SBF in comparison with plain CH. The bioactive effect on odontoblastic marker expression (ALP activity and mineralized matrix) was also observed for HDPCs continuously cultivated with conditioned medium obtained from scaffolds. Therefore, biomineralization of chitosan scaffolds containing different mineral phases was responsible for increasing the capacity for mineralized matrix deposition by pulpal cells, with potential for use in dentin tissue engineering.

Influence of selective immunosuppressive drug regimens on the healing of exposed dogs' dental pulp capped with a recent calcium silicate-based cement

OBJECTIVES

In the clinical medicine, immunosuppressive drugs are used for an assortment of disorders, while their effect on the pulp healing is a controversial issue. This study evaluated the effect of different immunosuppressive drugs on the healing capacity of mechanically exposed dogs' dental pulps after direct pulp capping (DPC) with calcium silicate-based cement.

MATERIALS AND METHODS

Twelve healthy male dogs were randomly allocated into four equal groups, 3 dogs each: group I allocated as a control group where no drugs were received; group П given prednisone (Pred); group III given a combination of Pred and cyclosporine A (CsA); and group IV given triple dose including Pred, CsA, and mycophenolate mofetil (MMF) for 45 days before the operative procedures and until the dogs were euthanized. In each dog, 16 class V cavities were prepared on the labial surfaces of anterior teeth. Following mechanical exposure, the pulps were capped with Biodentine, calcium silicate-based cement. The pulpal tissues response to Biodentine was assessed 65 days postoperatively.

RESULTS

The pulp healing response was inferior in the Pred-CsA- and Pred-CsA-MMF-treated groups compared with the control and Pred-treated groups (P < 0.05). Non-significant difference was found between control and Pred-treated groups (P > 0.05).

CONCLUSIONS

Within the limitation of this study, DPC with calcium silicate-based cement performed under strict aseptic condition for traumatically exposed dental pulp can be considered as a successful treatment option for those who receiving Pred immunosuppressive therapy. Meanwhile, DPC with those receiving a combination of Pred, CsA, and/or MMF immunosuppressive drug regimens demonstrated unfavorable results.

CLINICAL RELEVANCE

Direct capping of mechanically exposed pulps with calcium silicate-based cement performed with special care for preventing infection considered a suitable strategic measure for preserving pulp vitality in patients receiving corticosteroid immunosuppressive drug.

Green Hydrogels Composed of Sodium Mannuronate/Guluronate, Gelatin and Biointeractive Calcium Silicates/Dicalcium Phosphate Dihydrate Designed for Oral Bone Defects Regeneration

Innovative green, eco-friendly, and biologically derived hydrogels for non-load bearing bone sites were conceived and produced. Natural polysaccharides (copolymers of sodium D-mannuronate and L-guluronate) with natural polypeptides (gelatin) and bioactive mineral fillers (calcium silicates CaSi and dicalcium phosphate dihydrate DCPD) were used to obtain eco-sustainable biomaterials for oral bone defects. Three PP-x:y formulations were prepared (PP-16:16, PP-33:22, and PP-31:31), where PP represents the polysaccharide/polypeptide matrix and x and y represent the weight % of CaSi and DCPD, respectively. Hydrogels were tested for their chemical-physical properties (calcium release and alkalizing activity in deionized water, porosity, solubility, water sorption, radiopacity), surface microchemistry and micromorphology, apatite nucleation in HBSS by ESEM-EDX, FT-Raman, and micro-Raman spectroscopies. The expression of vascular (CD31) and osteogenic (alkaline phosphatase ALP and osteocalcin OCN) markers by mesenchymal stem cells (MSCs) derived from human vascular walls, cultured in direct contact with hydrogels or with 10% of extracts was analysed. All mineral-filled hydrogels, in particular PP-31:31 and PP-33:22, released Calcium ions and alkalized the soaking water for three days. Calcium ion leakage was high at all the endpoints (3 h-28 d), while pH values were high at 3 h-3 d and then significantly decreased after seven days (p < 0.05). Porosity, solubility, and water sorption were higher for PP-31:31 (p < 0.05). The ESEM of fresh samples showed a compact structure with a few pores containing small mineral granules agglomerated in some areas (size 5-20 microns). PP-CTRL degraded after 1-2 weeks in HBSS. EDX spectroscopy revealed constitutional compounds and elements of the hydrogel (C, O, N, and S) and of the mineral powders (Ca, Si and P). After 28 days in HBSS, the mineral-filled hydrogels revealed a more porous structure, partially covered with a thicker mineral layer on PP-31:31. EDX analyses of the mineral coating showed Ca and P, and Raman revealed the presence of B-type carbonated apatite and calcite. MSCs cultured in contact with mineral-filled hydrogels revealed the expression of genes related to vascular (CD31) and osteogenic (mainly OCN) differentiation. Lower gene expression was found when cells were cultured with extracts added to the culture medium. The incorporation of biointeractive mineral powders in a green bio-derived algae-based matrix allowed to produce bioactive porous hydrogels able to release biologically relevant ions and create a suitable micro-environment for stem cells, resulting in interesting materials for bone regeneration and healing in oral bone defects.

Biocompatibility and Osteogenic Potential of Calcium Silicate-Based Cement Combined with Enamel Matrix Derivative: Effects on Human Bone Marrow-Derived Stem Cells

The characteristics of retrograde filling material are important factors that can affect the long-term success of apical microsurgery. Various calcium silicate-based cements (CSC) were introduced to overcome drawbacks of mineral trioxide aggregate (MTA), while Emdogain is known to be effective in the regeneration of periodontal tissues. The aim of this study is to evaluate the biocompatibility and osteogenic potential of various CSCs combined with Emdogain on human bone marrow-derived mesenchymal stem cells. Experimental groups were classified into eight groups depending on the material and the presence of Emdogain. In the cell-counting kit test, all experimental groups combined with Emdogain showed higher cell viability compared with those without Emdogain at days 1 and 2. In the wound-healing assay, cell migration increased significantly over time, with or without Emdogain. In the alkaline phosphatase assay, all groups treated with Emdogain showed higher activity compared with those without Emdogain at day 3 (p < 0.05). Using alizarin red S staining, all groups treated with Emdogain showed greater calcium nodule formation compared with those without Emdogain at days 7 and 14 (p < 0.05). In conclusion, using CSCs as retrograde filling materials and the application of additional Emdogain will increase bone regeneration and improve the prognosis of apical microsurgery.

Local Drug Delivery Systems for Vital Pulp Therapy: A New Hope

Vital pulp therapy (VPT) is deliberated as an ultraconservative/minimally invasive approach for the conservation of vital pulpal tissues, preservation of dental structure, and maintenance of tooth function in the oral cavity. In VPT, following the exposure of the dental pulp, the environment is prepared for the possible healing and probable refunctionalisation of pulpal connective tissue. However, to succeed in VPT, specific biomaterials are used to cover and/or dress the exposed pulp, lower the inflammation, heal the dental pulp, provoke the remaining odontoblastic cells, and induce the formation of a hard tissue, i.e., the dentinal bridge. It can be assumed that if the employed biomaterial is transferred to the target site using a specially designed micro-/nanosized local drug delivery system (LDDS), the biomaterial would be placed in closer proximity to the connective tissue, may be released in a controlled and sustained pattern, could properly conserve the remaining dental pulp and might appropriately enhance hard-tissue formation. Furthermore, the loaded LDDS could help VPT modalities to be more ultraconservative and may minimise the manipulation of the tooth structure as well as pulpal tissue, which could, in turn, result in better VPT outcomes.

Biological parameters, discolouration and radiopacity of calcium silicate-based materials in a simulated model of partial pulpotomy

AIM

To analyse the discolouration, radiopacity, pH and calcium ion release of Biodentine (BD), Bio-C repair (BCR) and Bio-C temp (BCT), as well as their biological effects on human dental pulp cells (hDPCs).

METHODOLOGY

Sixty-four extracted bovine incisors were prepared to simulate crown fractures with pulp exposure and open root apex. The roots were filled using a mixture of agar and blood (control), and BD, BCR or BCT were placed over this mixture. Colour assessment analyses of the samples were performed before and immediately after material insertion and repeated at 30 and 90 days, using a spectrophotometer. The colour change of each specimen was evaluated at the crown and calculated based on the CIELab colour space. Digital radiographs were acquired for radiopacity analysis. hDPCs were placed in contact with different dilutions of culture media previously exposed to such materials and tested for cell viability using the MTT assay. The pH and calcium ion release of all materials were measured after 24 h; the data were assessed using one-way analysis of variance (ANOVA). Cell viability was analysed by two-way ANOVA. Differences in colour parameters and wound-healing data were assessed by two-way repeated measures ANOVA (α = 0.05). Tukey's and Dunnett's tests were used to compare the experimental groups with the control group.

RESULTS

BCR had grater radiopacity and smaller colour alteration (ΔEab/ΔE00) than the other materials tested (p < .005; p < .001). No significant differences in pH were found amongst the tested materials (p > .05). BCT was associated with the largest release of calcium ions (p < .0001). BD had cell viability similar to that of the control at the lowest dilutions, and BCR was similar to that of the control, regardless of the dilution tested (p > .05). BCT had a lower percentage of viability than that of the control at all tested dilutions (p < .0001). Cell migration rates in BD and BCR were similar to those in the control group after 24 h and 48 h (p > .05), whilst BCT had larger voids than the control in both periods (p < .0001).

CONCLUSIONS

BCR, BCT and BD were associated with tooth discolouration. BCR had the lowest staining values, the highest radiopacity and viability greater than 80% hDPCs.

Does MTA provide a more favourable histological response than other materials in the repair of furcal perforations? A systematic review

BACKGROUND

There is no consensus on which furcal perforation repair material induces a more favourable histological response. This systematic review of laboratory studies provides an overview of the studies comparing repair materials in animal models.

OBJECTIVES

To evaluate whether mineral trioxide aggregate (MTA) yields a more favourable histological response than other materials when used to repair furcal perforations in animal experimental models.

METHODS

This review followed the PRISMA checklist. The studies included various materials used to repair furcal perforations and compared the histological responses with MTA. An electronic search was conducted in EMBASE, PubMed, Scopus and Web of Science up to 2 September 2020, with no language or publication date restrictions. Studies whose full text was unavailable were excluded. The ARRIVE and SYRCLE tools were used to assess the methodological quality and risk of bias (RoB) of the studies.

RESULTS

The studies included in the qualitative synthesis were conducted in rat (n = 3) and dog (n = 17) models. They were classified as having a low quality, high methodological heterogeneity and high RoB. MTA and Biodentine, the materials most often compared, reduced the inflammatory reaction to mild over time. In addition, a mineralized tissue was formed in all studies. The response yielded by MTA was better than or equivalent to that of the other tested materials.

DISCUSSION

This review confirmed that MTA is the reference standard material for furcal perforation repair. However, research using animal models has inherent limitations, and the substantial methodological heterogeneity across the studies included should be considered. Therefore, the knowledge generated by this systematic review should be translated into clinical practice cautiously.

CONCLUSIONS

Features described in the report and quality assessment guidelines, such as PRIASE, ARRIVE and SYRCLE, should guide researchers. Despite the high RoB and the low methodological quality of the studies included, findings indicated that MTA yields a more favourable histological response than other materials in the repair of furcal perforations.

REGISTRATION

PROSPERO (CRD42020181297).

New Bioactive Calcium Silicate Cement Mineral Trioxide Aggregate Repair High Plasticity (MTA HP)-A Systematic Review

Bioactive calcium silicate cement Mineral Trioxide Aggregate (MTA) has been used for years as a gold standard in intravital pulp treatment and specialist endodontic procedures. Owing to flaws of the material, the manufacturers have been trying to enhance and produce materials showing improved physical, chemical and biological parameters. One of the new calcium-silicate cements based on mineral trioxide aggregate, however without some flaws exhibited by the cement, is Mineral Trioxide Aggregate Repair High Plasticity (MTA HP). The aim of the present paper was a systematic literature review concerning the MTA HP material used nowadays in dentistry, as a review of its specific features. The present paper is the first article providing a systematic literature review on MTA HP. The aim of the present article is the better understanding of MTA HP properties, which can aid the decision-making process in endodontic treatment.

A Systematic Review Comparing Mineral Trioxide Aggregate to Other Commercially Available Direct Pulp Capping Agents in Dogs

Vital pulp therapy (VPT) and direct pulp capping (DPC) are procedures regularly performed in dogs for the management of acute tooth fractures and as part of management for traumatic malocclusions. The purpose of this review is to apply an evidence-based medicine approach to systematically review and evaluate the scientific literature evaluating the efficacy of mineral trioxide aggregate (MTA) to other commercially available materials used for VPT in the permanent teeth of dogs. The 9 studies meeting inclusion criteria were reviewed and each studies evidence was classified using a grading system modified from the Oxford Centre for Evidence-Based Medicine. For the studies meeting inclusion criteria, MTA consistently performed as well or better than other commercially available products in terms of calcific barrier formation and biocompatibility. This review found a lack of consistency between the studies making a direct comparison of the results unreliable. Future studies would benefit from the implementation of a standard scoring system for histology, equivalent and longer study duration times and the correlation of histological and radiographic data.

Biomaterial and Biofilm Interactions with the Pulp-Dentin Complex-on-a-Chip

Calcium silicate cements (CSCs) are the choice materials for vital pulp therapy because of their bioactive properties, promotion of pulp repair, and dentin bridge formation. Despite the significant progress made in understanding CSCs' mechanisms of action, the key events that characterize the early interplay between CSC-dentin-pulp are still poorly understood. To address this gap, a microfluidic device, the "tooth-on-a-chip," which was developed to emulate the biomaterial-dentin-pulp interface, was used to test 1) the effect of CSCs (ProRoot, Biodentine, and TheraCal) on the viability and proliferation of human dental pulp stem cells, 2) variations of pH, and 3) release within the pulp chamber of transforming growth factor-β (TGFβ) as a surrogate of the bioactive dentin matrix molecules. ProRoot significantly increased the extraction of TGFβ (P < 0.05) within 24 to 72 h and, along with Biodentine, induced higher cell proliferation (P > 0.05), while TheraCal decreased cell viability and provoked atypical changes in cell morphology. No correlation between TGFβ levels and pH was observed. Further, we established a biofilm of Streptococcus mutans on-chip to model the biomaterial-biofilm-dentin interface and conducted a live and dead assay to test the antimicrobial capability of ProRoot in real time. In conclusion, the device allows for direct characterization of the interaction of bioactive dental materials with the dentin-pulp complex on a model of restored tooth while enabling assessment of antibiofilm properties at the interface in real time that was previously unattainable.

Lyophilized Ready-to-Use Mix for the Real-Time Polymerase Chain Reaction Diagnosis

Real-time polymerase chain reaction (real-time PCR) brings a more efficient and accurate method for detecting and analyzing nucleic acids in hospitals and laboratories. To solve the inconvenience of PCR reagent delivery and storage via cold-chain transportation, a solid-state reagent with robust characteristics should be employed. In this report, a lyophilized mix containing all necessary components for real-time PCR and its production method was designed, and its stability was tested at different temperatures. Some cryoprotectants and carriers are required to protect the function of the enzyme and primer as much as possible and provide the cake structure. Formulations with polyhydroxy compounds were considered to have the potential for protecting the enzymatic microstructure and functionality of dried mixes during the whole manufacturing and cold-free storage. The final products with the most superior protective formulation containing trehalose, Ficoll 400, and gelatin were able to provide the totally same testing result and sensitivity as the freshly made mix after 300 days of storage at 45 °C and can be deduced to maintain the function at room temperature (22.5-25.5 °C) for about 2 years.

Antibiotics or No Antibiotics, That Is the Question: An Update on Efficient and Effective Use of Antibiotics in Dental Practice

The antimicrobial resistance (AMR) phenomenon is an emerging global problem and is induced by overuse and misuse of antibiotics in medical practice. In total, 10% of antibiotic prescriptions are from dentists, usually to manage oro-dental pains and avoid postsurgical complications. Recent research and clinical evaluations highlight new therapeutical approaches with a reduction in dosages and number of antibiotic prescriptions and recommend focusing on an accurate diagnosis and improvement of oral health before dental treatments and in patients' daily lives. In this article, the most common clinical and operative situations in dental practice, such as endodontics, management of acute alveolar abscesses, extractive oral surgery, parodontology and implantology, are recognized and summarized, suggesting possible guidelines to reduce antibiotic prescription and consumption, maintaining high success rates and low complications rates. Additionally, the categories of patients requiring antibiotic administration for pre-existing conditions are recapitulated. To reduce AMR threat, it is important to establish protocols for treatment with antibiotics, to be used only in specific situations. Recent reviews demonstrate that, in dentistry, it is possible to minimize the use of antibiotics, thoroughly assessing patient's conditions and type of intervention, thus improving their efficacy and reducing the adverse effects and enhancing the modern concept of personalized medicine.

Minimal Intervention in Dentistry: A Literature Review on Biodentine as a Bioactive Pulp Capping Material

Root canal treatment has been the treatment of choice for carious pulp exposures. In the perspective of minimally invasive dentistry and preventive endodontics, a direct pulp capping procedure with a reliable bioactive material may be considered an alternative approach provided that the pulp status is favorable. However, the treatment of pulp exposure by pulp capping is still a controversial issue with no clear literature available on this topic, leaving the concerned practitioner more confused than satisfied. Biodentine is a relatively new bioactive material explored for vital pulp therapy procedures. This article discusses its role in direct pulp capping procedures. A thorough literature search of the database was done using PubMed, Google Scholar, and Scopus using the keywords preventive endodontics, calcium silicate cement, direct pulp capping, Biodentine, and vital pulp therapy. Reference mining of the articles that were identified was used to locate other papers and enrich the findings. No limits were imposed on the year of publication, but only articles in English were considered. This paper is aimed at reviewing the current literature on Biodentine as a direct pulp capping material. The review will provide a better understanding of Biodentine's properties and can aid in the decision-making process for maintaining the vitality of exposed dental pulp with minimal intervention.